Pharmacy Technicians Course. LaGuardia Community College

Pharmacy Technician Certification Exam : Knowledge statements and Study GuideThe following are thesis and topics covered in class but are commonly easily forgotten for the testInformation in this powerpoint presentation was gathered from previous exams and some other test material by meUsed the information here to supplement the knowledge you gained in classMedications that require special handlingNitroglycerin, Nitroprusside, Paclitaxel, and Fat Emulsions and amiodarone require IV infusion set that dont have PVC or DHEP plasterizer.Nitroprusside is light sensitive and the IV bag and IV set should be cover with a light opaque mediumPradaxa (Dabigatran) is a anticoagulant used in place of warfarin for many condition. FDA in 2011 requires that the pharmacist dispense drug in the orginal container and the bottle be dated 60 days after opening

Medications that require refrigeration storageGeneric (Brand)IndicationInterferon 1B (Betaseron) IV vialsMultiple SclerosisErthyromycin/Benozyl Peroxide (Benzamycin ) GelAcneAlprostadil (Caverject) VialsErectile DysfunctionEstradiol/norethinedrone Patchs (Combipatch)ContraceptionDesmopressin (DDAVP) IV vialsDiabetes insipidusEtanercept (Embrel) vial kitsVarious Autoimmune diseasesErythropoetin (Procrit, Epogen)RBC disordersGeneric (brand)IndicationsHuman InsulinsDiabetes MellitusHuman Growth Hormone (Humatrope)Dwarfism, short stature in childrenLopinavir/Ritonovir (Kaletra oral sol)HIV infectionSaquinavir (Fortovase) capsulesHIV infectionSalmon Calcitonin (Miacalcin) nasal syprayOsteoporosisOctreotide (Sandostatin)Various endocrine disordersErthyromcyin Ethyl Succinate oral soln(EES oral solution)Bacterial infectionsRibavirin/Interferon (Rebetron)HBV infectionsEtoposide (Vepeside) capsulesCancerChlorambucil (Leukeran) tabletsCancerTeriparatide (Forteo)Bone osteoporosisMedication that must be Frozen for storageGeneric (Brand)IndicationMMR (measles, mumps and Rubella)vaccinationVarivax (Varicella Zoster vaccine)vaccinationMost refrigerated medications should be refrigerated by the patient while taking at home. The most notable exception are insulin products, they may be keep at room temperature by the patient and they must be dated with a 28 day expiration from date vials are openMedication that cause photosensitivity in PatientsIts the responsibility of the pharmacist to advise patients using these drugs to wear protect clothing when in the day sunlight and using these drugsThis reaction does not always happen but when it does may cause a severe sun burn type reaction

GenericBrandDoxycycline and other Tetracycline drugsVariousSulfonamide drugsVariousRetinoids Accutane and othersSulfonylureas (Glipizide)GlucotrolDiuretics (Furosemide and HCTZ)Lasix and HydrodiurilDapsoneVariousOutdated Medication WarningRemember that expired tetracycline products are unsafe.Expired tetracycline products can cause Fanconis syndrome, a disorder of the kidney that can produce dangerous electrolyte abnormalities in patientsWhen in doubt, discard these medicationsProcessing Rx ordersNo federal law states that a technician can not receive a phoned in Rx; however some state prohibit this for phoned in new prescriptionsDAW codes helps insurance companies determine reimbursements for drugsDAW code are universal for all payersDAW 0 means generic productDAW 1 means MD wants brandThere are actually up to 8 codes, the DAW 5 code means pharmacist selects brand but is willing to accept generic reimbursementOne of the most important elements on the dispensed product label is the initials of the pharmacistAll new patients to your pharmacy it is important to give them a copy of the HIPPA notice of privacy practices and to document that the patient received it; same holds true for doctors officesMedicare Modernization Act of 2003 established the MTM, Medication therapy managementIntent was to reduce health care costs due to poor use of medication by patientsPharmacists to help discover these problems and fix themAllows for billing of insurance for these services by submitting CPT codesInsurance company use CPT code for billing (Current procedural terminology)

Assisting the pharmacist with Insurance issuesMedicareGovernment insurance for those over 65Patients young that 65 with certain disabilitiesAny age patient with end stage renal diseasePart A=hospitalPart B= office Part C= Medicare advantagePart D= Rx drug coveragePart D was signed into law in 2003Provide Rx coverage to seniorsPremium depends on planAll plans have coverage up to $2,830/year after which the patient covers all the cost of the drugAfter the patients reaches $4,550 in cost, Plan D kicks in a catastrophic Rx coverage where it pays 100% of the costThis gap is called the donutholeAffordable Care Act of 2010 (Obamacare)Provides financial relief to needy patients that fall into the donutholeOne time $250 rebate in 201050% reduction in cost of some drugs. The savings are counted towards the donuthole7% discount on other drugs in the Part DMedigap InsuranceSome patients have medicare and medicare supplemental private insurance plans as secondary insuranceMedicare is the primary insurance, always bill medicare first for any pharmacy related service; if medicare does not pick up all the cost then charge the balance to the secondary insuranceMedicaidGovernment health insurance for needy people, pregnant women, teenagers, individuals who are legally blindState splits the cost with the federal governmentAfter a pharmacy submits a claim, we are paid at the MAC (maximum allowable cost) which is based on U&Cs (usual and customary costs publish by the drug companies)Other government programsWorkers CompensationA worker injured on the job and that requires prescription medications will have no copay for drugsPharmacy files paperwork with employer to the state and federal governmentsTRICARE is the health insurance plan that services uniformed armed services men and womenCHAMPVA (civilian health and medical program of the veteran administration) is insurance for permanently disable veterans and their family membersAdjudication Denial CodesWhen a pharmacy claim is rejected it could be because of Refill too soonExpired coveragePrescribed quantity exceed limits of insurance planThe most annoying areNDC not covered which means that insurance will not pay for the drug who selected to fill the Rx; fix is to try another generic with a different NDCPrescriber not covered: patients MD is not a part of the insurance network; patient need to change MD or pay for drug.US FDA publishes the Orange BookOrange Book publishes ratings data on drug therapeutic equivalence between drugsFor drugs to be consider therapeutically equivalent, they must have a rate of AB or better Drugs that have B ratings are not therapeutically equivalent and substitution between them is not permittedFDA restricted drugsSome drugs have strong side effects such that the FDA mandate special rules in the marketing of these drugsPrior to 2007,FDA restricted drug program was called RiskMAP, risk mitigation action plansAfter 2007 the new standards are called REMS, risk mitigation evaluation and mitigation strategiesFor some drugs the REMS involves distributing PPI with each script (Oral Contraceptives, Hormone products (Estradiol), Accutane, and Inhaler products); others involve drug manufacturer to set up registries of patients, prescribers and pharmaciesREMS Special programsDrugREMSSpecial requirementsFentanyl Transmucosal Systems (Actiq)Transmucosal Immediate Release Fentanyl (TIRF) REMS Registration of wholesalers and pharmacies to dispense productsAccutane (Isotrenoin)I Pledge REMSPatient and Prescribers must be enrolled, Female patients must have a negative pregnancy test and use two forms of birth control, Pharmacies must enrolled to orderAvandia productsRosiglitazone Medicines Access ProgramPrescibers/patients must enroll and only specialty pharmacies stock itClozapineClozaril National Registry Prescribers and patients must be enrolled; must provide ANC and WBC count to pharmacy, pharmacy must enroll to orderProcrit and Epogen and AranespAPPRISE REMSPrescribers must enrolled in program, patient must sign form to understand the risksAlosetron (Lotronex)PPL (Prescribing program for lotronex)Prescribers must enroll, patients must sign form, pharmacy to dispense with PPL sticker on RXPaperwork requirementsIf pharmacy wants to file a claim to Medicare for pharmacy services and/or durable medical equipment (DME) must use paper claim form, CMS 1500DEA 222 for ordering CII drugs must be attached to invoice and filed for 2 years (Federal law). ALL controll substance invoices are saved for 2 yearsAll outpatient prescriptions for controlls must be saved for 2 years, after the date of last fillingRotation of Pharmacy stockRotate medications with the longer expiration behind those with the earliest medications on the shelfWith controlled substances, Federal law says if you group controlled substances together you must keep them in a locked area (like a locked cabinet). If you dont want to lock the drugs, you must scatter the drugs among your regular stock. Lock or scatter-your choice Commercially Prepared dehydrated powder medications for oral useProducts: Amoxicillin, Augmentin, Clindamycin, Zithromycin, and may other antibioticsOnce mixing these antibiotics with water: a 14 day expiration is used under refrigerationExceptions: Augmentin (amoxicillin/clavulunate potassium) and Biaxin (clarithromycin) are both 10 daysRemember these, very commonRadiopharmaceuticalsNuclear pharmacy provides radiopharmaceutical for use of imaging, and therapy of cancerExamples: Indium 111 capromab for prostate cancer imaging, Iodine 131 for thyroid cancer, and strontium 89 for metastatic cancer bone painIn general preparation requires use of a BSC cabinet of type 3. This BSC is completely enclosed, often called glove box BSC.Distance and speed principle is followed, aseptic technique is performed fast and with tongs (for distance) to minimize exposure to pharmacy personnel StorageFederal law defines the following:Room temperature= 59-86 F or 15-30 CRefrigeratored temperature= 36-46 F or 2-8 CFreezer temperature= below 32 F or 0 C

Extemperaneous CompoundingPharmacy makes a unique product dose form for a specific patient, i.e acetaminophen 2% creamUSP 795 (not 797) says that expiration dating for these products should not exceed 25% of the time remaining among the manufacturer drug product or six months into the future which ever is earliestAny product where water is add to a solid dosage form is given 14 days under refrigeration unless published data state otherwiseGelatin capsules come in sizes from 000 to 13.00o is the largest size13 is the smallest sizePrepacking and Unit dose systemsHelps in inventory management in hospitalsPrepacked and unit dose blister cards by law are permitted to be return to inventory upon returnExpiration dating are one of two systems50% of the expiration date on the manufacturer drug or 1 year whichever is sooner (my hospital uses this)USP 795 guideline: 25% or six months whichever is soonerCombat Methamphetamine Act of 2005Products containing ephedrine or pseudoephedrinePseudoephedrine products include: Pseudofed, formally in DayQuil and NyquilUsed to make illegal crystal meth or ice on the streetCurrently ephedrine based diet pills (uses outside allergy, asthma, and traditional chinese use) are banned by the FDA (since 2006).Aside these, all these products are kept behind the counter in the pharmacy.A log book must be keepID is required to be verified by the pharmacistNo more than 3.6 grams/day for any one personNo more than 9 grams/month for any one personMedications that should not be prepacked (unit dose)The standard unit dose prepackage machine as a mechanical dial that rotates between metal plates that are heated to high temperatures. Oral dose forms are placed on the dial and the metal plates seal the blister pack material around the medication with heatSome medications should not be prepacked with a standard machine because the machine will become contaminated with dust particles from these drugsAt times a dedicated machine can be used for some of these drugsCommon highly allergic potential drugs include:Penicillins, Cephalosporins, sulfa drugsMoisture Sensitive medicationsPyridostigmine (Mestinon)Prasugrel (Effluent)EmtrivaMost orally melting tablets : Risperdal M

CapsulesMost gelatin capsules will melt when exposed to heatRitonovirOmega 3 Fatty Acids capsulesChemotherapy drugs and Teratogenic drugsChlorambucil (Leukeran)Cyclophosphamide (Cytotaxan)Cyclosporin (Gengraf)Bosentan (Tracleer): Pregnancy category XIn general, always inquire about the pregnancy rating and the cytotoxic potential of drugs before you are asked to prepack anything. (especially if you are a woman of childbearing potential)For a more complete listing visit:http://www.ashp.org/s_ashp/docs/files/MedNO_unit-dosedpackage.pdf